血浆BNP检测对心力衰竭患者心功能分级评价中的作用

摘要

目的 探讨血浆B型钠尿肽(B-type natriuretic peptide,BNP)浓度在诊断慢性心力衰竭(chronic heart failure,CHF)及心功能分级评价中的作用.方法 采用化学发光微粒子酶免疫分析法测定89例CHF患者及40名健康对照者血浆BNP浓度.依据美国纽约心脏病协会(New York Heart Association,NYHA)分级方案对CHF患者进行心功能分级.结果 血浆BNP诊断CHF临界值为111.7 pg/ml,灵敏度88.16%,特异性94.29%;CHF组血浆BNP浓度为574.3±176.2 pg/ml,明显高于对照组66.7±17.5 pg/ml,P＜0.05.CHF患者NYHA心功能Ⅰ级到Ⅳ级血浆BNP逐渐升高,各级之间BNP浓度比较,P＜0.05;血浆BNP水平与NYHA分级间存在明显的正相关,r=0.835,P＜0.001.各级NYHA分级CHF患者经治疗后血浆BNP水平显著下降,与治疗前相比,P＜0.05.结论 CHF患者血浆BNP水平随着心力衰竭严重程度的增加而升高,血浆BNP可以准确评价心功能,可作为临床诊断、疗效观察以及预后判断CHF的客观指标.%Objective To investigate the value of plasma B-typc natriurctic peptide (BNP) assay for evaluation of heart function in chronic heart failure (CHF) patients. Methods The concentrations of plasma BNP were measured by microparticlc enzyme immunoassay in 89 patients with CHF and 40 control subjects. The heart function was classified according to the New York Heart Association (NYHA) criteria. Results At the clinical decision threshold of 111. 7 pg/ml,thc plasma BNP demonstrated a diagnostic sensitivity and specificity of 88. 16% and 94. 29% ,respectively. The concentration of of plasma BNP in patients with CHF was 574. 3± 176. 2 pg/ml, which was higher than healthy control, 66. 7+17. 5 pg/ml,P<0. 05. The concentrations of plasma BNP increased gradually with more severe symptoms (NYHA class I -Ⅳ and was positively correlated with NYHA class (r = 0. 835,P<0. 001). After the CHF patients were given treatment, the concentrations of plasma BNP were obviously reduced in each NYHA class, compared with prcthcrapy,P<0. 05. Conclusion The concentration of plasma BNP in patients with CHF significantly elevated with the severity of heart failure and and was positively correlated with NYHA class. It can better reflect the heart function, and can be served as a effective marker of clinical diagnosis, observation of therapeutic effect, risk stratification and judgement of prognosis in patients with CHF.